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01-06-2016 | The Science of Prevention (JD Stekler and J Baeten, Section Editors)

PrEP as Peri-conception HIV Prevention for Women and Men

Authors: Renee Heffron, Jillian Pintye, Lynn T. Matthews, Shannon Weber, Nelly Mugo

Published in: Current HIV/AIDS Reports | Issue 3/2016

Abstract

Daily oral tenofovir (TDF)-based pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy and recommended for men and women with substantial risk of HIV acquisition. The peri-conception period, the stage prior to pregnancy when condom use is necessarily reduced, has elevated HIV risk that can be mitigated by PrEP use. Data from a randomized trial suggest that peri-conception PrEP use by HIV-seronegative women does not increase the risk of pregnancy loss, birth defects or congenital anomalies, preterm birth, or infant growth faltering. Women considering PrEP use throughout pregnancy must weigh the known increased risk of HIV acquisition with unknown risks of drug effects on infant growth. PrEP has been used safely by HIV-seronegative men with HIV-seropositive female partners who have become pregnant. As an effective user-controlled HIV prevention strategy, PrEP offers autonomy and empowerment for HIV prevention and can be recommended alongside antiretroviral therapy, fertility screening, vaginal self-insemination, intercourse timed to peak fertility, medically assisted reproduction, and other safer conception strategies to provide multiple options. The integration of PrEP into safer conception programs is warranted and will safely reduce HIV transmission to women, men, and children during the peri-conception period.

Mugo NR, Heffron R, Donnell D, Wald A, Were EO, Rees H, et al. Increased risk of HIV-1 transmission in pregnancy: a prospective study among African HIV-1-serodiscordant couples. AIDS. 2011;25:1887–95.CrossRefPubMedPubMedCentral

Gray RH, Li X, Kigozi G, Serwadda D, Brahmbhatt H, Wabwire-Mangen F, et al. Increased risk of incident HIV during pregnancy in Rakai, Uganda: a prospective study. Lancet. 2005;366:1182–8.CrossRefPubMed

Murnane PM, Celum C, Mugo N, Campbell JD, Donnell D, Bukusi E, et al. Efficacy of preexposure prophylaxis for HIV-1 prevention among high-risk heterosexuals: subgroup analyses from a randomized trial. AIDS. 2013;27:2155–60.CrossRefPubMed

Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367:399–410.CrossRefPubMedPubMedCentral

Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367:423–34.CrossRefPubMed

Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381:2083–90.CrossRefPubMed

Kojima N, Klausner J. Is emtricitabine-tenofovir disoproxil fumarate preexposure prophylaxis for the prevention of human immunodeficiency virus infection safer than aspirin? Open Forum Infect Dis. 2016;3. doi:10.1093/ofid/ofv221.

Matthews LT, Smit JA, Cu-Uvin S, Cohan D. Antiretrovirals and safer conception for HIV-serodiscordant couples. Curr Opin HIV AIDS. 2012;7:569–78.CrossRefPubMedPubMedCentral

Finocchario-Kessler S, Champassak S, Hoyt MJ, Short W, Chakraborty R, Weber S, et al. Pre-exposure prophylaxis (PrEP) for safer conception among serodifferent couples: findings from healthcare providers serving patients with HIV in seven US cities. AIDS Patient Care STDS. 2016. doi:10.1089/apc.2015.0268.

10.

U. S. Public Health Service. Pre-exposure prophylaxis for the prevention of HIV infection in the United States—2014. 2014 Clinical Practice Guideline 2014. http://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf. Accessed 27 Sep 2015.

11.

Callahan R, Nanda K, Kapiga S, Malahleha M, Mandala J, Ogada T, et al. Pregnancy and contraceptive use among women participating in the FEM-PrEP trial. J Acquir Immune Defic Syndr. 2015;68:196–203.CrossRefPubMed

12.

Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367:411–22.CrossRefPubMedPubMedCentral

13.

Mugo NR, Hong T, Celum C, Donnell D, Bukusi EA, John-Stewart G, et al. Pregnancy incidence and outcomes among women receiving preexposure prophylaxis for HIV prevention: a randomized clinical trial. JAMA. 2014;312:362–71.CrossRefPubMedPubMedCentral

14.

Bunge K, Balkus J, Noguchi L, Pan J, Piper J, Marrazzo J, et al. Pregnancy incidence and outcomes in women receiving tenofovir-based PrEP in the VOICE trial, Abstract MOPEC480. In: International AIDS Society. Vancouver, Canada; 2015.

15.

Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372:509–18.CrossRefPubMedPubMedCentral

16.

Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral Pregnancy Registry International Interim Report for 1 January 1989 through 31 January 2013. In: Wilmington, NC: Registry Coordinating Center; 2013.

17.

Wilcox AJ, Weinberg CR, O’Connor JF, Baird DD, Schlatterer JP, Canfield RE, et al. Incidence of early loss of pregnancy. N Engl J Med. 1988;319:189–94.CrossRefPubMed

18.

Were EO, Heffron R, Mugo NR, Celum C, Mujugira A, Bukusi EA, et al. Pre-exposure prophylaxis does not affect the fertility of HIV-1-uninfected men. AIDS. 2014;28:1977–82.CrossRefPubMedPubMedCentral

19.

Brown Jr RS, McMahon BJ, Lok AS, Wong JB, Ahmed AT, Mouchli MA, et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: a systematic review and meta-analysis. Hepatology. 2016;63:319–33.CrossRefPubMed

20.

Chen HL, Lee CN, Chang CH, Ni YH, Shyu MK, Chen SM, et al. Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother-to-infant transmission of hepatitis B virus. Hepatology. 2015;62:375–86.CrossRefPubMed

21.

Celen MK, Mert D, Ay M, Dal T, Kaya S, Yildirim N, et al. Efficacy and safety of tenofovir disoproxil fumarate in pregnancy for the prevention of vertical transmission of HBV infection. World J Gastroenterol. 2013;19:9377–82.CrossRefPubMedPubMedCentral

22.

Greenup AJ, Tan PK, Nguyen V, Glass A, Davison S, Chatterjee U, et al. Efficacy and safety of tenofovir disoproxil fumarate in pregnancy to prevent perinatal transmission of hepatitis B virus. J Hepatol. 2014;61:502–7.CrossRefPubMed

23.

Wang L, Kourtis AP, Ellington S, Legardy-Williams J, Bulterys M. Safety of tenofovir during pregnancy for the mother and fetus: a systematic review. Clin Infect Dis. 2013;57:1773–81.CrossRefPubMed

24.

Siberry GK, Williams PL, Mendez H, Seage 3rd GR, Jacobson DL, Hazra R, et al. Safety of tenofovir use during pregnancy: early growth outcomes in HIV-exposed uninfected infants. AIDS. 2012;26:1151–9.CrossRefPubMedPubMedCentral

25.

Fowler MG, Qin M, Fiscus SA, Currier J, Makanani B, Martinson FE, et al. PROMISE: efficacy and safety of 2 strategies to prevent perinatal HIV transmission, Abstract 31LB. In: CROI 2015. Seattle, USA; 2015.

26.

Siberry GK, Jacobson DL, Kalkwarf HJ, Wu JW, DiMeglio LA, Yogev R, et al. Lower newborn bone mineral content associated with maternal use of tenofovir disoproxil fumarate during pregnancy. Clin Infect Dis. 2015;61:996–1003.CrossRefPubMed

27.

Pintye J, Langat A, Singa B, Kinuthia J, Odeny B, Katana A, et al. Maternal tenofovir disoproxil fumarate use in pregnancy and growth outcomes among HIV-exposed uninfected infants in Kenya. Infect Dis Obstet Gynecol. 2015;2015:276851.CrossRefPubMedPubMedCentral

28.

Liotta G, Floridia M, Andreotti M, Jere H, Galluzzo C, Mancinelli S, et al. Growth and bone markers in malawian infants pre- and postnatally exposed to tenofovir, Abstract 879. In: CROI 2015. Seattle, USA; 2015.

29.

Williams P, Yildirim C, Crain M, Hazra R, Van Dyke RB, Rich K, et al. Congenital anomalies and in utero antiretroviral exposure in HIV-exposed uninfected infants, Abstract 863LB. In: CROI 2015. Seattle, USA; 2015.

30.

Himes SK, Wu JW, Jacobson DL, Tassiopoulos K, Hazra R, Kacanek D, et al. Meconium tenofovir concentrations and growth and bone outcomes in prenatally tenofovir exposed HIV-uninfected children. Pediatr Infect Dis J. 2015;34:851–7.CrossRefPubMed

31.

Hill A, Khoo S, Back D, Pozniak A, Boffito M. Should the dose of tenofovir be reduced to 200–250 mg/day, when combined with protease inhibitors? J Int AIDS Soc. 2014;17:19583.PubMedPubMedCentral

32.

Stellbrink HJ, Orkin C, Arribas JR, Compston J, Gerstoft J, Van Wijngaerden E, et al. Comparison of changes in bone density and turnover with abacavir-lamivudine versus tenofovir-emtricitabine in HIV-infected adults: 48-week results from the ASSERT study. Clin Infect Dis. 2010;51:963–72.CrossRefPubMed

33.

Pintye J, Langat A, Singa B, Kinuthia J, Odeny B, Katana A, et al. Maternal tenofovir disoproxil fumarate (TDF) use in pregnancy not associated with adverse growth outcomes at 6 weeks and 9 months among Kenyan HIV-exposed uninfected infants. In: International AIDS Society 2015. Vancouver, Canada; 2015

34.

Levison J, Weber S, Cohan D. Breastfeeding and HIV-infected women in the United States: harm reduction counseling strategies. Clin Infect Dis. 2014;59:304–9.CrossRefPubMed

35.

Ehrhardt S, Xie C, Guo N, Nelson K, Thio CL. Breastfeeding while taking lamivudine or tenofovir disoproxil fumarate: a review of the evidence. Clin Infect Dis. 2015;60:275–8.CrossRefPubMed

36.

Flynn PM, Mirochnick M, Shapiro DE, Bardeguez A, Rodman J, Robbins B, et al. Pharmacokinetics and safety of single-dose tenofovir disoproxil fumarate and emtricitabine in HIV-1-infected pregnant women and their infants. Antimicrob Agents Chemother. 2011;55:5914–22.CrossRefPubMedPubMedCentral

37.

Porter M, Davies MA, Mapani MK, Rabie H, Phiri S, Nuttall J, et al. Outcomes of infants starting antiretroviral therapy in Southern Africa, 2004–2012. J Acquir Immune Defic Syndr. 2015;69:593–601.CrossRefPubMed

38.

Onah HE, Iloabachie GC, Obi SN, Ezugwu FO, Eze JN. Nigerian male sexual activity during pregnancy. Int J Gynaecol Obstet. 2002;76:219–23.CrossRefPubMed

39.

Kinuthia J, Drake AL, Matemo D, Richardson BA, Zeh C, Osborn L, et al. HIV acquisition during pregnancy and postpartum is associated with genital infections and partnership characteristics. AIDS. 2015;29:2025–33.CrossRefPubMed

40.

Dinh TH, Delaney KP, Goga A, Jackson D, Lombard C, Woldesenbet S, et al. Impact of maternal HIV seroconversion during pregnancy on early mother to child transmission of HIV (MTCT) measured at 4–8 weeks postpartum in South Africa 2011–2012: A National Population-Based Evaluation. PLoS One. 2015;10:e0125525.CrossRefPubMedPubMedCentral

41.

Johnson LF, Stinson K, Newell ML, Bland RM, Moultrie H, Davies MA, et al. The contribution of maternal HIV seroconversion during late pregnancy and breastfeeding to mother-to-child transmission of HIV. J Acquir Immune Defic Syndr. 2012;59:417–25.CrossRefPubMedPubMedCentral

42.

Centers for Disease C, Prevention. Interim guidance for clinicians considering the use of preexposure prophylaxis for the prevention of HIV infection in heterosexually active adults. MMWR Morb Mortal Wkly Rep. 2012;61:586–9.

43.

World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. In: Geneva, Switzerland: World Health Organization; 2015.

44.

Matthews LT, Mukherjee JS. Strategies for harm reduction among HIV-affected couples who want to conceive. AIDS Behav. 2009;13 Suppl 1:5–11.CrossRefPubMed

45.

Vernazza PL, Graf I, Sonnenberg-Schwan U, Geit M, Meurer A. Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child. AIDS. 2011;25:2005–8.CrossRefPubMed

46.

Whetham J, Taylor S, Charlwood L, Keith T, Howell R, McInnes C, et al. Pre-exposure prophylaxis for conception (PrEP-C) as a risk reduction strategy in HIV-positive men and HIV-negative women in the UK. AIDS Care. 2014;26:332–6.CrossRefPubMed

47.

Matthews LT, Heffron R, Mugo NR, Cohen CR, Hendrix CW, Celum C, et al. High medication adherence during periconception periods among HIV-1-uninfected women participating in a clinical trial of antiretroviral pre-exposure prophylaxis. J Acquir Immune Defic Syndr. 2014;67:91–7.CrossRefPubMedPubMedCentral

48.

Heffron R, Thomson K, C C, NR M, Katabira E, Bukusi E, et al. Fertility intentions, pregnancy and PrEP use in African HIV serodiscordant couples, Abstract TUPEC511. In: IAS 2015. Vancouver, Canada; 2015.

49.

Schwartz SR, West N, Phofa R, Yende N, Sanne I, Bassett J, et al. Acceptability and preferences for safer conception HIV prevention strategies: a qualitative study. Int J STD AIDS. 2015. doi:10.1177/0956462415604091.

50.

Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000;342:921–9.CrossRefPubMed

51.

Vernazza P, Hirschel B, Bernasconi E, Flepp M. Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitement antirétroviral efficace ne transmettent pas le VIH par voie sexuelle (HIV infected patients under HAART without any other sexually transmitted infection do not transmit HIV by sexual intercourse). Bull Med Suisses. 2008;89:165–9.

52.

Hoffman RM, Jaycocks A, Vardavas R, Wagner G, Lake JE, Mindry D, et al. Benefits of PrEP as an adjunctive method of HIV prevention during attempted conception between HIV-uninfected women and HIV-infected male partners. J Infect Dis. 2015;212(10):1534–43.

53.

Letchumanan M, Coyte PC, Loutfy M. An economic evaluation of conception strategies for heterosexual serodiscordant couples where the male partner is HIV-positive. Antivir Ther. 2015;20:613–21.CrossRefPubMed

54.

Mujugira A, Celum C, Thomas KK, Farquhar C, Mugo N, Katabira E, et al. Delay of antiretroviral therapy initiation is common in East African HIV-infected individuals in serodiscordant partnerships. J Acquir Immune Defic Syndr. 2014;66:436–42.CrossRefPubMedPubMedCentral

55.

Heffron R, Ngure K, Mugo N, Celum C, Kurth A, Curran K, et al. Willingness of Kenyan HIV-1 serodiscordant couples to use antiretroviral-based HIV-1 prevention strategies. J Acquir Immune Defic Syndr. 2012;61:116–9.CrossRefPubMedPubMedCentral

56.

Katz IT, Essien T, Marinda ET, Gray GE, Bangsberg DR, Martinson NA, et al. Antiretroviral therapy refusal among newly diagnosed HIV-infected adults. AIDS. 2011;25:2177–81.CrossRefPubMedPubMedCentral

57.

Siedner MJ, Santorino D, Lankowski AJ, Kanyesigye M, Bwana MB, Haberer JE, et al. A combination SMS and transportation reimbursement intervention to improve HIV care following abnormal CD4 test results in rural Uganda: a prospective observational cohort study. BMC Med. 2015;13:160.CrossRefPubMedPubMedCentral

58.

Rosen S, Fox MP. Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review. PLoS Med. 2011;8:e1001056.CrossRefPubMedPubMedCentral

59.

Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. J Acquir Immune Defic Syndr. 2006;43 Suppl 1:S23–35.CrossRefPubMedPubMedCentral

60.

Semrau K, Kuhn L, Vwalika C, Kasonde P, Sinkala M, Kankasa C, et al. Women in couples antenatal HIV counseling and testing are not more likely to report adverse social events. AIDS. 2005;19(6):603–9.

61.

Msuya SE, Mbizvo EM, Hussain A, Uriyo J, Sam NE, Stray-Pedersen B. Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs. AIDS Care. 2008;20(6)700–9.

62.

Farquhar C, Kiarie JN, Richardson BA, Kabura MN, John FN, Nduati RW, et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr. 2004;37:1620–6.CrossRefPubMedPubMedCentral

63.

Bachanas P, Medley A, Pals S, Kidder D, Antelman G, Benech I, et al. Disclosure, knowledge of partner status, and condom use among HIV-positive patients attending clinical care in Tanzania, Kenya, and Namibia. AIDS Patient Care STDS. 2013;27:425–35.CrossRefPubMedPubMedCentral

64.

Peltzer K, Jones D, Weiss SM, Villar-Loubet O, Shikwane E. Sexual risk, serostatus and intimate partner violence among couples during pregnancy in rural South Africa. AIDS Behav. 2013;17:508–16.CrossRefPubMedPubMedCentral

65.

De Schacht C, Hoffman HJ, Mabunda N, Lucas C, Alons CL, Madonela A, et al. High rates of HIV seroconversion in pregnant women and low reported levels of HIV testing among male partners in Southern Mozambique: results from a mixed methods study. PLoS One. 2014;9(12):e115014.

66.

Matthews LT, Moore L, Crankshaw TL, Milford C, Mosery FN, Greener R, et al. South Africans with recent pregnancy rarely know partner’s HIV serostatus: implications for serodiscordant couples interventions. BMC Public Health. 2014;14:843.CrossRefPubMedPubMedCentral

67.

Tam M, Amzel A, Phelps BR. Disclosure of HIV serostatus among pregnant and postpartum women in sub-Saharan Africa: a systematic review. AIDS Care. 2015;27:436–50.CrossRefPubMed

68.

Ngure K, Baeten J, Mugo NR, Curran K, Vusha S, Heffron R, et al. My intention was a child but I was very afraid: fertility intentions and HIV risk perception among HIV-serodiscordant couples experiencing pregnancy in Kenya. AIDS Care. 2014;26:1283–7.CrossRefPubMedPubMedCentral

69.

Grossman D, Onono M, Newmann SJ, Blat C, Bukusi EA, Shade SB, et al. Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial. AIDS. 2013;27 Suppl 1:S77–85.CrossRefPubMed

70.

Cooper D, Mantell JE, Moodley J, Mall S. The HIV epidemic and sexual and reproductive health policy integration: views of South African policymakers. BMC Public Health. 2015;15:217.CrossRefPubMedPubMedCentral

71.

Murnane P, Heffron R, Ronald A, Bukusi E, Donnell D, Mugo N, et al. Pre-exposure prophylaxis for HIV-1 prevention does not diminish the pregnancy prevention effectiveness of hormonal contraception. AIDS. 2014;28(12):1825–30.CrossRefPubMedPubMedCentral

72.

Heffron R, Mugo N, Were E, Kiarie J, Bukusi EA, Mujugira A, et al. Preexposure prophylaxis is efficacious for HIV-1 prevention among women using depot medroxyprogesterone acetate for contraception. AIDS. 2014;28:2771–6.CrossRefPubMedPubMedCentral

73.

Heffron R, Davies N, Cooke I, Kaida A, Mergler R, van der Poel S, et al. A discussion of key values to inform the design and delivery of services for HIV-affected women and couples attempting pregnancy in resource-constrained settings. J Int AIDS Soc. 2015;18 Suppl 5:20272.PubMedPubMedCentral

74.

Onono M, Guze MA, Grossman D, Steinfeld R, Bukusi EA, Shade S, et al. Integrating family planning and HIV services in western Kenya: the impact on HIV-infected patients’ knowledge of family planning and male attitudes toward family planning. AIDS Care. 2015;27:743–52.CrossRefPubMed

75.

Kahle EM, Hughes JP, Lingappa JR, John-Stewart G, Celum C, Nakku-Joloba E, et al. An empiric risk scoring tool for identifying high-risk heterosexual HIV-1-serodiscordant couples for targeted HIV-1 prevention. J Acquir Immune Defic Syndr. 2013;62:339–47.CrossRefPubMedPubMedCentral

76.

Balkus JE, Brown E, Palanee T, Nair G, Gafoor Z, Zhang J, et al. An Empiric HIV Risk Scoring Tool to Predict HIV-1 Acquisition in African Women. J Acquir Immune Defic Syndr. 2016. doi:10.1097/QAI.0000000000000974.

77.

Heffron R, Cohen C, Ngure K, Bukusi E, Were E, Kiarie J, et al. A scoring tool to identify East African HIV-1 serodiscordant partnerships with a high likelihood of pregnancy. PLoS One. 2015;10(12):e0145515.

78.

Baeten J, Heffron R, Kidoguchi L, Mugo N, Katabira E, Bukusi E, et al. Near elimination of HIV transmission in a demonstration project of PrEP and ART. In: CROI 2015: Conference on Retroviruses and Opportunistic Infections. Seattle, Washington, USA; 2015. p. Abstract 24.

Title: PrEP as Peri-conception HIV Prevention for Women and Men
Authors: Renee Heffron
Jillian Pintye
Lynn T. Matthews
Shannon Weber
Nelly Mugo
Publication date: 01-06-2016
Publisher: Springer US
Published in: Current HIV/AIDS Reports / Issue 3/2016
Print ISSN: 1548-3568
Electronic ISSN: 1548-3576
DOI: https://doi.org/10.1007/s11904-016-0312-1

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